The Death of Terri Schiavo: An Epilogue

Blurring the line between life and death, and between medical data and morality, her death signifies a disturbing turning point for American society.

Terri Schiavo died on March 31, 2005, after lasting 13 days without food or water. Her life and death had a profound impact on the American psyche and brought to the forefront the unresolved debate regarding how we treat severely disabled people and who should be their surrogate decision-makers. There is reason to be disturbed by the role that physicians play in molding public opinion regarding end of life issues, because their expertise is generally in medicine and not ethics.

This concern was reinforced by a particular email that arrived last week. I received a great deal of mail in response to my article arguing for the preservation Terri Schiavo's life. While most of the letters were supportive of my position, several were not. Since there is a great deal of ignorance in the world regarding end of life issues, and most people do not have the background to understand the intricacies of neurological impairment, I was not surprised by the negative comments. But I was particularly struck by a letter that I received from a neurologist, an expert on the brain -- the type of physician whose job it is to understand the fine shades of meaning that should shape the discussion of brain damage. He completely disagrees with my approach to the case and accuses me of not understanding Terri Schiavo's true condition. I have felt a visceral need to better explain why I think her death is such a turning point for American society. I can think of no better way to express my feeling than by responding to the neurologist's letter.

He wrote to me with what might appear to be a legitimate charge: that I (and by extension all others who argued for leaving in Terri Schiavo's feeding tube) am ignorant of what a persistent vegetative state means. The implication being that if one really understands such a condition, one could not possibly wish to preserve such a life. We must be intellectually honest enough to evaluate his critique and decide if it has merit. He states:

…I find myself in sharp disagreement with Dr. Eisenberg. The article refers to PVS as a "cognitively impaired" condition. In fact, there is no cognition whatsoever in someone who is in a persistent vegetative state. Modern aggressive emergency care developed over the last several decades, has allowed us to resuscitate patients with what would have been terminal hypoxic brain injury (what happened to Terri Schiavo). Unfortunately, the entire brain cortex becomes nonfunctional in these people and we are left with a functioning brainstem that allows for reflex eye movements, facial movements etc. PVS patients can even track a moving object in their field of vision because collicular function of the intact brainstem reflexively guides these eye movements. It is all too easy to imagine sentience in the PVS patient because, as humans, so much of our communication is nonverbal and cued by facial and eye movements.

His assessment of the persistent vegetative state is succinct and it is accurate. To the best of our medical understanding, we presume that a person in a persistent vegetative state has no cognition whatsoever. I never gave much credence to those who argued about the rehabilitation potential of Terri Schiavo. Not because I did not believe it to be true (I have no way of knowing), but because it really does not make a difference to outsiders like myself. CT scan results, Glascow Coma Scales, and following balloons are really only of interest to neurologists and family members who need to arrange for the best possible care for the patient.

As a society, what we must concern ourselves with are two questions: What is the significance of being so terribly impaired that there is no cognition and how should such people be treated? It is here that the doctor falls woefully short in his analysis. While I am sure that his credentials are impeccable and his understanding of neurology is excellent, he completely misunderstands the role that physicians should play in society's evaluation of end of life issues (as we will discuss) and he clearly does not appreciate where medical knowledge ends and morality begins.

His letter continued:

Nevertheless, the activity of our cerebral cortex is what distinguishes our very "humanness". If the cortex is dead, then the human individual is dead. . . If the cortex is destroyed, personhood ceases. PVS is an abomination of life --in essence a human shaped colony of cells with no sentience -- a glorified cell culture. . .Thankfully, I have not seen this irrational preservation of "life" at all costs in this situation since my training in the early 1970's. . . Patients with PVS and end-stage Alzheimer's disease routinely have IV's and feeding tubes removed in the United States every day.

The opinions expressed above are very widespread in the medical community today. Variations of these views are espoused by many of the physicians with whom I have discussed this topic. For this reason, they cannot be lightly brushed aside. Please understand that the issue is not autonomy (which is an independent and important issue), but the definition of life. Is the cerebral cortex what makes us human and is it true that "if the cortex is dead, then the human individual is dead"?

Of course not. My physician critic clearly has stepped beyond the bounds of medicine into the realm of philosophy, and that is the problem. As any physician knows, there is neither a state in America nor any sane physician in the world who would declare that someone who is in a persistent vegetative state is dead. If PVS really equals death then why bother pulling the feeding tube? Just bury the patient with the feeding tube still in place! The doctor's comments are clearly hyperbole, and represent a very insidious type of bias that leads people to equate PVS with death.

Terri Schiavo did not die of PVS; she died of starvation and dehydration.

Why do people do it? Because it allows them to feel comfortable that they are not murdering someone if the person that they "kill" is already dead. Terry Schiavo was not dead until two weeks after her feeding tube was removed. She did not die of PVS; she died of starvation and dehydration.

As hard as it may be for physicians to accept, the definition of death is not a medical one; it is a philosophical and societal one. While physicians certainly may participate in the debate, the value of their opinions should be weighed based on merit, not medical training. There are no medical criteria that can answer the fundamental question of what is life and what is death. Once society decides how it wants to determine death, then the physician is called upon to use his or her expert knowledge to confirm that the criteria have been met. While physicians may use their expertise to offer information to society's decision-makers so that the definition of death is grounded in accurate information, they have no more proficiency in the areas of ethics or philosophy than anyone else.

So our doctor's description of the impairments of the PVS patient are of course accurate -- no cognition whatsoever. However, what he fails to appreciate is that his medical credentials do not give him the right to make the leap from the clinical description of PVS to the statement "if the cortex is destroyed, personhood ceases. PVS is an abomination of life -- in essence a human shaped colony of cells with no sentience -- a glorified cell culture." What credentials were bestowed upon him that give him the right to decide which lives are worth preserving? The answer is that with a medical degree often comes hubris.

We have unfortunately seen such hubris result in terrible loss of life over the past century. The belief that medicine can determine which lives are worth preserving was an intrinsic part of the pre-Nazi German medical establishment (see "Why Medical Ethics"). In the late 1920's and early 1930's:

a number of prominent German academics and medical professionals were espousing the theory of "unworthy life," a theory which advanced the notion that some lives were simply not worthy of living. . . If Mengele himself (an infamous physician who performed murderous experiments on live concentration camp inmates) became a cold-blooded monster at the height of his Nazi career, he certainly learned at the feet of some of Germany's most diabolical minds. As a student Mengele attended the lectures of Dr. Ernst Rudin, who posited not only that there were some lives not worth living, but that doctors had a responsibility to destroy such life and remove it from the general population. His prominent views gained the attention of Hitler himself, and Rudin was drafted to assist in composing the Law for the Protection of Heredity Health, which passed in 1933, the same year that the Nazis took complete control of the German government. This unapologetic Social Darwinist contributed to the Nazi decree that called for the sterilization of those demonstrating the following flaws, lest they reproduce and further contaminate the German gene pool: feeblemindedness; schizophrenia; manic depression; epilepsy; hereditary blindness; deafness; physical deformities; Huntington's disease; and alcoholism1.

The scary part of the Terri Schiavo debate has been the blurring of the line between life and death, and between medical data and morality. Why does the medical knowledge of the physician seem to translate into skill in evaluating the value of life?

We are a society easily open to suggestion. Our opinions are strongly influenced by the media. And as Dr. Milgram proved with his obedience experiments, our moral judgments are most easily swayed by authority figures. So when doctors espouse a belief that some patients are "as good as dead," who are laypeople to disagree? We see the murderous outcome when our natural tendency to trust authority figures is exploited in the area of evaluating value of life. If the doctors tell us that some lives are not worth preserving, we may feel that we lack the knowledge to disagree. This drives home the crucial need to carefully assess who our authority figures are and whether they are functioning within the area of their expertise.

In an excellent article examining the role of nurses in the eugenics programs of Nazi Germany, Susan Benedict, a professor at the College of Nursing of the Medical University of South Carolina in Charleston, writes:2

During the Nazi era, so-called "euthanasia programs" were established for handicapped and mentally ill children and adults. Organized killings of an estimated 70,000 German citizens took place at killing centers and in psychiatric institutions...The German people were exposed to the idea of euthanasia through posters, movies, and books supporting the destruction of "lives not worth living". A 1936 book entitled Sendung und Gewissen (Mission and Conscience) was published in Germany by an ophthalmologist and was widely read. This novel told the story of a young wife with multiple sclerosis who was euthanized by her physician-husband. This novel was important in preparing the ground for the euthanasia programs3 It was made into a movie "Ich Klage an!" ("I Accuse") and was widely shown during these years. Two other popular movies of the time also dealt with euthanasia, Life Unworth Life (1934-1935) and Presence without Life (1940-1941)4 . "Opfer der Vergangenheit (Victims of the Past, 1937) was produced under Hitler's direct order and shown by law in all 5,300 German theaters."5 These films argued that keeping seriously ill people alive was against the basic principles of nature.

The results of the active participation of the medical community in the determination of which lives were worth preserving were devastating. "By the time the Third Reich lay in ruins, German doctors had sterilized at least 460,000 men and women diagnosed as unfit or disturbed… dispatched 250,000 to 300,000 chronically ill patients by means of starvation, gas inhalation, prolonged sedation and toxic injections; gassed and cremated more than 10,000 infants and children with disorders ranging from congenital heart disease to epilepsy."6 And so, with help of the medical establishment, the most civilized and scientifically advanced country in the world, destroyed its own people, because their lives were simply "not worth living."

Did these doctors and nurses appreciate how far they had strayed from their duty to care for the sick? Evidence from the Nuremberg trials seems to point to the inescapable conclusion that many of the perpetrators never appreciated the ethical disconnect between their actions and their medical mission. Their medical personas were subsumed into their political and philosophical views. It is only because they were doctors and nurses that they had the opportunity to cause such great harm. They became leaders in Nazi Germany7 and used their medical knowledge to further their personal utilitarian agendas.

The outcome of the case has called into question the lives of all disabled people.

I make no apology regarding my stance on the Terri Schiavo case. In the guise of misplaced compassion, using our legal system's "due process" as legal sanction, the American courts legalized the killing of those people whose lives are not worth living. Many Americans have accepted the information that they have seen in the media with little question. While the courts probably acted appropriately within the scope of their jurisdiction, the people of this compassionate nation should do some deep soul searching and ask themselves whether they have been sold a "bill of goods" and misled by those it trusts most -- its doctors and courts. Are we so sure that life without consciousness is not life?

The real significance of the Terri Schiavo case is not that one woman was killed. The outcome of the case has called into question the lives of all disabled people. Can the supporters of removing Terri Schiavo's feeding tube honestly answer why we should not euthanize a profoundly retarded child who will never have any real self awareness? Should depressed people with refractory deep depression be given lethal doses of painkillers for their own good? Who will be the arbiter of such decisions?

I worry that our society is descending once again into the abyss of a particularly pernicious form of ethical relativism which attributes value only to certain lives based on whatever set of standards are currently in vogue. As the value placed on life declines, but the cost of medical care increases, even greater pressure will be placed on the disabled (who "cost" too much to maintain) to do us all a favor and die. I sincerely hope that there is a remaining bastion of common sense and morality among the millions of Americans who have a basic faith in the value of life. They do not need medical degrees to understand that life is intrinsically valuable. They understand that life does not derive its value from the ability to derive enjoyment from the world. (see: Should Terri Schiavo Live or Die?)

The neurologist ended his letter in the following way:

Western neurologic practice, opinion and ethics recognize these conditions (PVS and Alzheimer's disease) as terminal in contradistinction to "Halachic law". It would seem that medical ethics at least in the U.S., has become more informed or evolved beyond an archaic Halachic law. Dr. Eisenberg states in his essay , "The key to analyzing any situation is to realize that good ethics start with good facts." On this, I wholeheartedly concur and as a bedside clinician who deals with these cases, would offer this as a prescription to Dr. Eisenberg.

Given a choice between the enlightened ethics of my correspondent and the "archaic" ethics of Jewish law, I really see no choice. He is not the first educated person to announce to the world that traditional ethics are passe. But throughout history, the cheapening of life has inevitably led to the deaths of innocent people. Whether it is a communist nation that devalues the intellectuals or ethnic groups that cheapen the lives of their rivals, in every instance the beginning of the end is the concerted attempt to convince the population that some lives just don't matter.

On the one hand I can take the Jewish approach, one that has consistently viewed every person as having a spark of God within them, regardless of their abilities (or complete lack of cognition), merely because God created them. On the other hand, I can take an approach that values a human life by its utility. Based on past experience, I would be making a very poor investment in the future of civilization to choose the latter. An ethic that values life will always be a better investment for society than one that demeans the lives of others.

FOOTNOTES
1http://www.crimelibrary.com/serial_killers/history/mengele/nazi_3.html?sect=6
2 Benedict, Susan, and Jochen Kuhla, "Nurses' Participation in the Nazi Euthanasia Programs," Western Journal of Nursing Research, April 1999, 21(2), 246-263. Can be viewed at http://www.baycrest.org/Winter%202002/article4.htm
3 Proctor, R. (1988). The destruction of "lives not worth living". In Racial Hygiene: Medicine Under the Nazis. Cambridge, MA: Harvard University Press, p. 183
4Amir, A. (1977). Euthanasia in Nazi Germany. Dissertation, State University of New York at Albany. University Microfilms International,p. 97.
5 Michalczyk, J. (1994). Euthanasia in Nazi propaganda films: Selling murder. In Medicine, Ethics, and the Third Reich: Historical and Contemporary Issues. Kansas City: Sheed and Ward, p. 65
6 Dr. Michael Thaler, "The Art and Science of Killing Children and Other Undesirable Beings," California Pediatrician, Fall 1992:
7 See the case of the Pernkopf atlas. Dr. Pernkopf, who was made head of the University of Vienna by the Nzais, created the best anatomic atlas ever produced, utilizing the bodies of political prisoners and concentration camp victims for his illustrations. He was an outspoken supporter of the Nazi eugenics theories and felt that it was his medical duty to further their agenda. See the discussion by the Kennedy Institute for Ethics at http://www3.georgetown.edu/research/nrcbl/hsbioethics/units/cases/unit3_2.html and the British Medical Journal (BMJ 1996;313:1422 -7 December) at http://bmj.bmjjournals.com/cgi/content/full/313/7070/1422 .

Related Articles:

About the Author

Dr. Daniel Eisenberg is with the Department of Radiology at the Albert Einstein Medical Center in Philadelphia, PA and an Assistant Professor of Diagnostic Imaging at Thomas Jefferson University School of Medicine. He has taught a Jewish medical ethics class for the past 15 years. Dr. Eisenberg writes extensively on topics of Judaism and medicine and lectures internationally on topics in Jewish medical ethics to groups of all backgrounds. Obtain more information on scheduling a lecture or learning more about Jewish medical ethics by visiting Dr. Eisenberg at www.daneisenberg.com

Visitor Comments: 85

(85)
Dr. Bernie Siegel,
November 10, 2014 12:31 AM

dying is not a problem

i told a woman who has been brain dead for two years and hospice attorneys said they would consider it murder to pull out her feeding tube the following: "your family is around your bed and they are too emotional to say this but they want you to know that your love will stay with them and if you need to go it is alright. she died 15 minutes later.

(84)
Alan,
November 9, 2014 6:12 PM

Advanced health directives

Dear Dr. Eisenberg, would your position regarding Ms. Schiavo change if she had signed a living will or other directive stating her instructions that feeding tubes should be withdrawn if she was ever diagnosed as PVS?

While the end of life may be a philosophical inquiry, so might be the continuation of life for persons diagnosed with PVS. Granted, one may be concerned about the slippery slopes into unworthy lives, but I see no evidence of such a discussion even being suggested.

I do not equate life with monetary value, if a society determines that persons who are in a PVS should be kept alive with the assistance of machines, etc., who in the society bears the cost of such decision?

Must we accept all available health care regardless of our situation and, if we need not accept all such care under particular situations, then is PVS such a situation?

(83)
Anonymous,
August 19, 2013 3:48 AM

Should we or shouldn't we?

My mother was semi conscious and her orders had been to us to let her die with dignity. She refused to eat. The director of the hospital was Catholic and insisted on putting in a feeding tube. I went to my Rabbi and he said if I wanted an answer to that question I would have to act on it. I thanked my Rabbi and left. My sister and I refused the feeding tube. My mother died as she wanted to and I thanked my Rabbi.

(82)
Steve,
June 17, 2012 11:42 AM

overreaching

Dr. Daniel Eisenberg goes way out of bounds likening the current medical establishments view of end of life management to Nazi era rationalization of methodologies to institute their ideas of a racially perfect aryan whatever.
It's absurd to say that medical professionals, or anyone for that matter, faced with very hard choices about their patients or loved ones, should be so seriously restricted in their best effort attempts to make final decisions as Dr. Eisenberg suggests.
Schiavo had literally no brain and no chance of recovery and Eisenberg would have anyone in such a state hover indefinitely through virtue of technology and nothing else. So the years would go by..... and thousands of major brain trauma victims with no hope of recovery, thought, action, or any cognition at all will pile up.... and their loved ones would all remain in a never ending torture of terrible psychological pain.
To suggest that people should suffer in such a way is ridiculous... and smells like taking a position simply to encourage readership.....
there's another guy who does this..... Howard Stern

(81)
LADYDI,
November 28, 2011 7:23 PM

I'm very torn on this issue. My wonderful aunt was hooked up to all kinds of machines to keep her alive when she was comatose. Machines fed her. Machines made her breathe. This went on for weeks on end. We loved her so much we just couldnt "let her go". When the ventilator was finally shut off, she didnt take a breath. Just silence. Dead silence that tore our hearts out. Then we realized that she had been "gone" for weeks - we just allowed modern medicine to give the impression she was alive, but it was just false hope. The machines faked us into believing this. What a nightmare.

Another said: " If people can no longer keep another "alive" except as a pump hooked up to machinery,is it not more merciful, and right, to remove the devices, to turn off the machines, to allow a soul to "drop it's body," and to allow "nature to take it's course" by following the will of G_d ?"

Others spoke about the woman's wishes not to be "kept alive artificially".

Yet another said "Did our sages ever envision a time when life could be sustained artificially thru a feeding tube and water intravenously? I would have to believe that withholding food and water for them meant not offering this to a person."

-------

So, is feeding a person who can not feed themselved "keeping them alive artificially"?

Where exactly would the line be drawn? A person who can't pick up the food and feed themselves and must be spoon fed? That's pretty extreme, but I'm sure someone would argue for it.

A person who can not swallow? There are people who are perfectly conscious and far from PVS who need a feeding tube because they can not swallow. What about premature babies that can't suck yet? Is feeding them "keeping them alive artificially?"

Who would determine where the line is drawn?

And what is "artificially", anyway? Medical intervention is generally "artificial". I suspect the people I quoted above would not intend to say that giving medicines is keeping someone alive "artificially", or that performing surgeryis keeping someone alive "artificially". What about a pacemaker -- is that more natural than feeding someone through a tube? Dialysis? Should we "allow nature to take it's course" and "follow the will of G-d" in those cases and others? Should we ask, "if diabetes equals life, then why bother giving insulin?

Perhaps the statements I quoted above were not really thought out carefully?What are you really saying?

(79)
Basya Perlman,
August 23, 2007 12:44 AM

Response to Lauren march 18 2007

Lauren,You said, "What the neurologist meant was that, once the cortex is dead, life can be continued, bu that person's soul...their personality, died along with the cortex"

I don't really understand this -- the soul is not physical but spiritual. We have no instruments which can measure when it leaves the body. You state, as if it is fact, that the soul died along with the cortex. On what basis can you make such a statement?

Medicine and science have no way to detect or measure the soul, so they can not make a statement one way or the other about when the soul leaves the body.

Perhaps this is an assumption you are making just because it "looks" like the person has no soul, since we can only relate to the physical and can not feel or see the presence of the soul?

This, of course, would not make this a statement of fact, but mere conjecture. On the basis of conjecture should we make life and death decisions?

(78)
Lauren,
March 18, 2007 11:19 PM

Death of the Cortex.

Upon reading the neurologist's letter on the situation, I am in total agreeance with him when he says "If the cortex is dead, personhood ceases." I belive you misinterpreted what he meant in his letter. You took it quite literally, thinking personhood to mean life. What the neurologist meant was that, once the cortex is dead, life can be continued, bu that person's soul...their personality, died along with the cortex and now their body is simply existing.

(77)
Christine Limric,
June 1, 2006 12:00 AM

Who was telling the truth? Schiavo vs Schindlers

I read the books which came out at the same time by Michael Schiavo and one by the Schindler family. Each side seemed to attack the other with very different versions of every single event in Terri's life. I still do not know who to believe after reading both books. Do you have an opinion as to what caused Terri's collapse? Do you really believe that Michael caused it as the Schindlers now claim? I found it curious that the Schindlers did not accuse Michael of any kind of abuse until he sought to have the feeding tube removed. As to the question of whether or not a person in PVS is really alive and human, I am torn about that. I would not want to to be kept alive that way....with no real thoughts or feelings. And I worked at a hospital for 8 years and saw a young man who was in just such a state linger on for 10 years only to die from complications from respiratory distress and digestive problems. Let me know if you read the Schiavo and Schindler books. Thank you.

(76)
Anonymous,
November 20, 2005 12:00 AM

All souls are alive and serve G-d in their own way

Doctors and lawyers ultimately make these life/death decisions by their willingness or unwillingness to continue treating the family member (patient to them) who relies on them. The average person has no recourse but to follow their directives. When doctors and lawyers have lower morals than the average person does, it is not a good sign.

(75)
Susan Bender,
November 3, 2005 12:00 AM

But would it be OK for your parents to care for you for 20 years?

Terri Schiavo left no living will. I disagree that a profoundly retarded person can be compared to PVT. What if she did leave instructions not to be kept alive in this situation. Would the principle of autonomy take precedence in that circumstance? I would not want this kind of living death for my family to suffer through.
If I'm going to lie in a nursing home bed for 10 or 20 years before I die, why not die at my "appointed" time rather than being kept alive artifically? Certainly the case can be made that many patients are not allowed to die once they've because part of the medical-industrial complex. You are equating allowing a person to die with an act of euthenasia, and these acts are not morally equivalent.

(74)
Shira Levin,
August 1, 2005 12:00 AM

The Devaluation of Life

I totally agree with Dr. Eisenberg. To
me it is a case of the doctors and the
court that set up Terri's legalized
murder where placing themselves in G-d's
place. He is the one who gives life as
Creator in the first place. One of His
commandments is "Thou Shalt Not Murder.
Therefore, only G-d has the right to take a life not man.

(73)
Hayim,
May 27, 2005 12:00 AM

Dr Eiseberg's bias

On a whole Dr Eisenberg is honest and responsible in his position, and laudably seeks to protect both society and democracy from slippery-slope of fashion-of-the-day relativism.

In one thing though, Dr Eisenberg's bias comes through. He says:

"What is the significance of being so terribly impaired that there is no cognition and how should such people be treated?"

He begins with the assumption that people with 'no cognition' are still people, and he continues with it. Apparently, the critic he is responding to has overstepped his bounds in claiming otherwise - that he is preempting a necessary moral decision which can only be made by society. There is, however, a difference between medical science informing a moral debate, and doctors attempting to veto society where medicine meets ethics.

Perhaps there is legislation, and hopefully a societal consensus, that PVS is life, but when criticism of this comes from disciplines intimately familiar with nerological conditions, as opposed to ethicists, we should at least listen - everyone seems to agree that these decisions should be made with the best possible grounding.

Dr Eisenberg says: "If PVS really equals death then why bother pulling the feeding tube?". Does he suppose then that a computer, an organism of electronic parts, represents life simply becaue it must be plugged into a power supply to continue? Does he suggest that we ought to re-animate the brainstems (and the functions it regulates) of normally pronounced dead? Or to develope technology to this end?

One could easily ask: "If PVS really equals life, then why bother inserting a feeding tube?" Taken to the extreme this idea is clearly insidious, but it is also not withot flaws in Dr Eisenberg's version.

The emergence of the "life support system" raises difficult questions and blurs the line of where life ends. Dr Eisenberg is commendable for erring on the side of caution, but criticism levelled against the kinds of medical assumption an ethicist might use does not constitute hubris on the side of the scientist. Rather it is a necessary input for informing moral debate.

(72)
Susan Brooks,
May 10, 2005 12:00 AM

Conditioning

The most important point is that Americans are being not-very-gradually conditioned to accept horror. Apparently, for 82% of the population, it is working.

(71)
Catherine Woodward,
May 9, 2005 12:00 AM

What happened in the Terri Schiavo case was heart renching. It's not 100% clear that Terri was in a persistent vegetative state. There were cases where people who were judged to be in a persistent vegetative state; and the judgement was wrong. Here is the proof.

The study drew a distinction between MCS and Persistent Vegetative State (PVS), but the distinction is not a reliable one. In a New York Times article, Dr. Joseph Fins mentioned research indicating a 30% misdiagnosis rate of PVS, indicating that nearly a third of persons diagnosed in PVS are actually in "minimally conscious state." Fins is chief of the medical ethics division of New York Presbyterian Hospital-Weill Cornell Medical Center.
Even with this technology, there will probably still be mistakes. But at least it will be the first step in reducing the number of conscious people dying from hunger and thirst in hospitals and nursing homes, aware of every minute and unable to cry out that they are awake Dr. David Stevens, who says most so-called experts have never seen someone die under such circumstances.
With mistakes like this being made Michael and Judge Greer should have decided on life instead of death for Terri. Even, if Terri was in a persistent vegetative state; to have this poor humanbeing die of starvation and dehydration was anything but merciful.
The way dehydration effects the body is horrible. Here is the proof.
Stevens, who represents a group of 17,000 physicians, explained what happens with starvation:
As dehydration begins, there is extreme thirst, dry mouth and thick saliva. The patient becomes dizzy, faint and unable to stand or sit; has severe cramping in the arms and legs as the sodium and potassium concentrations in the body goes up as fluids go down. In misery, the patient tries to cry but there are no tears. The patient experiences severe abdominal cramps, nausea and dry-heaving as the stomach and intestines dry out.
By now the skin and lips are cracking and the tongue is swollen. The nose may bleed as the mucous membranes dry out and break down. The skin loses elasticity, thins and wrinkles. The hands and feet become cold as the remaining fluids in the circulatory system are shunted to the vital organs in an attempt to stay alive. The person stops urinating and has severe headaches as their brain shrinks from lack of fluids. The patient becomes anxious but then gets progressively more lethargic.
Some patients have hallucinations and seizures as their body chemistry becomes even more imbalanced. This proceeds to coma before death occrs. The final event as the blood pressure becomes almost undetectable is a major heart arrhythmia that stops the heart from pumping.

Judge Greer needed to look further as to whether Terri was indeed in a persistent vegetative state or not; after all there were some doubts about Terri's condition.
The understanding we, now have of the human brain and its capabilities is still in its infancy stage.

(70)
Keith Ironside MD,
May 6, 2005 12:00 AM

Medical ethics

To solve for the purpose of action, a philosophical question, arguement is required to develop a consensus. In the practice of critical care medicine, action is required on a daily basis with regard to those with the persistent vegetative state. Support in decision making comes from neurologists, other physicians, lay persons, family, legal consultants and religious representatives. At no time is a person with hubris and certitude useful in solving these issues which are by their nature inherently complex. There is no demagogue who can be allowed to be the supreme dictator for these problems, nor can a consensus of all citizens solve them either. To blanket another professionals, or lay persons, discussion of such an issue with derision derails consensus. In fact, that is what was achieved in the Terry Schavo case.

(69)
Robert Krutenat,
April 29, 2005 12:00 AM

Right on Doctor.Eisenberg

An outstanding review of the issues.

(68)
Jeffrey A. Pomykala,
April 27, 2005 12:00 AM

Reply to Mr. Mcelwee

Joseph, you seem to miss some points concerning the Schiavo case. She WASN'T hooked up to any machines! (other than monitors). A feeding tube is exactly what it sounds like - a tube. The person is fed through this tube. There is no "machinery" that was keeping her alive and MOST certainly, starving someone to death is not "letting nature takes it's course" and DEFINITELY not in G-d's will.
Read all the commentaries - you might gain a little more incite if you put aside your own particular biases towards "quality of life".
...with all due respect.

(67)
Mervin H. Needell,
April 26, 2005 12:00 AM

The Schiavo case does turn on autonomy

Dr. Eisenberg states categorically on page 3 that “the issue is not autonomy.” But I claim just as categorically that the issue is indeed autonomy. In fact the entire Terri Schiavo case turns precisely on Terri’s autonomy. The decision to discontinue gastrostomy feedings was based on Terri’s wish, as reported by her husband, that she did not want to be kept alive by artificial means were she to lose consciousness permanently. If we accept the husband’s report as fact, then modern bioethics demands and the law requires that her wish be honored, and the feeding tube must be withdrawn. The decision to withdraw the tube did not depend on the doctors’ wishes, or the public’s wishes, or the husband’s wishes. If Terri had stated prior to losing consciousness that she wished to be kept alive despite permanent loss of consciousness, then her caretakers would have been obligated ethically and legally to do exactly as she wished and maintain her alive. Thus the deciding factor was autonomy, namely Terri’s autonomy. It had nothing to do with the “value of life,” as assessed by the doctors, by the public, or by the husband. It also had nothing to do with the status of Terri’s brain, or whether her life was or was not worth living, or even if life without consciousness is or is not life.

One might make the argument that the husband was mistaken (or was lying), in which case the decision might turn on a question of fact rather than of ethics or of law, specifically that of what her autonomy entailed. To my knowledge, nobody in the controversy made that argument. No one disputed the husband’s statement regarding his wife’s specific will. Even Dr. Eisenberg does not dispute the husband’s report.

One might question whether she was permanently unconscious. Her parents seemed to claim that, given more time or better treatment, Terri might recover. If she had even a remotely reasonable chance to recover consciousness, her caregivers would be obligated to keep her alive. This would be strictly a medical determination. After a dozen or so years with no objective evidence of improvement, Terri had no credible medical testimony for recovery. To the contrary, all of her treating and consulting credentialed physicians gave her no reasonable chance to recover. Even so, they would have been obligated to continue feeding her if she had wished such treatment. Again, it would have been a question of autonomy. On page 6 Dr. Eisenberg asks: “Who will be the arbiter of such decisions?” The answer is that the patient and the patient alone is the arbiter, provided he or she is (or was) mentally competent to do so.

Of course, if we do not know the permanently unconscious patient’s autonomous will, then we would have to fall back on a beneficent standard, such as the patient’s best interests (as best as we can determine them), and failing that, to determine what we think a reasonable person in the patient’s circumstances would want. In Terri’s case, the highest standard, that of her autonomous will, was known and thus had both ethical and legal priority.

(66)
Merlock,
April 24, 2005 12:00 AM

Terri Didn't Even Start It

I know someone (who is incredibly disturbed, in my opinion) who, before Terri was even on TV, advocated to me that all people who are unable to pull their weight in society---the old, sick, disabled, whatever---should be left on their own to starve to death. He said this, by the way, knowing I have an autistic brother. And for years, countless women have, using prenatal testing, decided to abort babies with Trisomy-21 (Down Syndrome) and other congenital disorders. Abortion basically devalues life based on whether or not their parents want it; euthanasia is legal in the Netherlands; in some places, like Canada or even Texas, the government or hospitals have the right to decide which lives are worth using resources on.

Terri is a tragedy. I felt like crying when I heard she died. But now that I stop and think about it, tragedies have been going on for a long time now. Thanks for the article, and God bless everyone.

(65)
Joseph D. Weinman McElwee,
April 23, 2005 12:00 AM

Oh,come on now!

Oh, come on now!
"Just bury the patient with the feeding tube still in place"! I assume this means that the pumping apparatus,the electricity, and the chemicals would accompany it. Your hyperbole shows the weak point ofyour arguement. If people can no longer keep another "alive" except as a pump hooked up to machinery,is it not more merciful, and right, to remove the devices, to turn off the machines, to allow a soul to "drop it's body," and to allow "nature to take it's course" by following the will of G_d ?

(64)
Linda H. Hawkins,
April 18, 2005 12:00 AM

I am also disturbed by neurologist's letter

Even our veterinarian does not presume to make the kind of statements made by this doctor, when we present to him a disabled pet! He tells us everything that he knows about the condition, offers available options, and leaves the decision about what to do next to us. This is as it should be. This is the extent of his role and his authority. This is where the guardians of that animal must start using their own consciences. Neither does the news media have any business getting involved...or the courts, or the government. They have no right to even make a suggestion.

How much more so, concerning a human being. I feel that no one should have gotten involved in the Shiavo case except her spouse, her family, and their Creator. Once the "authority figures" outside that circle became involved, they all overstepped their boundaries. They all saw an opportunity to proclaim their importance and test its limits. Their involvement circumvented the natural processes that this family needed to go through. It degraded everyone in the scenario. Like yourself, I was frightened by the implications of this case--that "authorities" are going to be able to take these kinds of decisions "off our hands."

No! Not these kinds of decisions! They are for the people who love us to make. Whatever consensus they reach, it will be out of their love, not their intoxication with power. If the courts had never gotten involved in the Schiavo case, the family could have eventually worked through their issues. How do we keep these kinds of cases out of the wrong hands??

(63)
Nancy Havernick,
April 16, 2005 12:00 AM

Child neurologist supports Dr. Eisenberg

As a child neurologist, I care for several patients who do not appear any more responsive to their environment than Terri Shiavo did. I saw some of them in the weeks that Terri was being starved to death. Their families and care-givers were rightfully concerned. Though these children require a lot of care, most families are quite devoted to them and feel that the disabled child plays an important role in the family. I was as disappointed in Terr's doctors as in her estranged husband who chose to end her life. There is a big difference between a do not ressusitate order which is not uncommon for severely ill or brain injured patients, especially older patients, and starving someone to death. The former saves someone from heroic attempts at reversing natural death which are not often successful. The latter is murder. Like Dr. Eisenberg, I choose life.

(62)
Sharon Stern MD,
April 16, 2005 12:00 AM

What about the woman's wishes?

I read with interest your response to the neurologist's email. I have not read your original article. I, too, was disturbed by the neurologist overstepping his bounds as a physician and assuming the ethicist/philosopher/societal role (with presumed authority and commission). I am an intensive care specialist by training and have certainly participated in my fair share of end of life scenarios. If, in truth, Terri and her husband had discussed 'what if' scenarios and specifically asked that she not be supported in such a state as PVS, then I believe that her wishes were appropriate to be carried out. I don't have to agree with patients or their families as to the course of action they wish to take with a loved one; whether it is to continue treatments that may or may not sustain life or to withdraw them. Our society has legislated that advanced directives and durable powers of attorney are legally binding. Perhaps this is where the issue is most confusing in this case, as apparently Mrs. Schiavo had not executed any legal documentation; but rather it was only verbal. I am with you one hundred percent, though, in my disgust with how terms such as 'vegetable', or 'brain dead' have been tossed around in such a manner to diminish this woman or any one else's inherent dignity, beauty, and right to our deepest care and concern for the simple fact that we are all made in the image of our creator. Hopefully the dialogue this tragic situation has opened will provide for this country to seriously consider what our moral temperature is right now. Thank you for the dialogue.

(61)
Anonymous,
April 16, 2005 12:00 AM

Thank you for standing up for what you believe. I am a disabled person born with my problems that is the way God made me.

I feel God mades us and it should be God who decides when to take us home not a medical person or someone who feel that we would be a burden. We all have a devine purposose or I feel God would not have put us here.

What is currently going on is like our past in Germany of my grandparents and parents. We fought to keep this from happing and now it is starting in our country.

My husband and I are in aggreement that what happen to Teri is murder and all involved will have to answer to God for this crime.

(60)
Miriam,
April 15, 2005 12:00 AM

Humane?

What is practical to human life is not arguing over who is worthy of life. Everyone is worthy of life. This is not to be determined by human beings except in cases where one life threatens another it is permissible to defend oneself. Those who cannot defend themselves have a right to be protected.

This is the way America was. And, this is a constitutional right that differentiates the humane aspect of a person from biology.

Unless a person knows what it feels like to have PVS or any other handicap we, as people, have no right to judge what quality of life means to them.

Practical medicine is focused on the meaning of quality of life to the patient. Terry Shiavo was Catholic. That determined quality of life outside of science and medical science ignored that based on heresay.

Wrong direction.

Very sad for her, for medicine and the legal system.

To "how-many-cases?"-David: Get a living will or what could G-d forbid happen to you, is spending the last two weeks of your life starving to death after 15 years of adapting to a disability millions of Americans have and adapt to though it's different. (Most people with disabilities develop higher functioning in other areas to compensate the loss of functioning in a particular area. Keep that in mind when you make out your will cause you might be more aware than you think you would or could be or anyone would notice, G-d forbid.)

(59)
Anonymous,
April 15, 2005 12:00 AM

it's worse

I just read your article because a friend sent me and I really agree with you in most sentences.
I think the worst problem of today's society is that the majority of humans just worry about money and an easy way of life. Terri Schiavo was obviously murdered (not forgetting the really horrible way she was killed!) and uncountable others are murdered the same way-all over the globe- for the same reason , they are an expensive ''encumbrance'' and they aren't seen as living individuals at all.
Even if they aren't killed -most disabled, feeble, sick or dying humans are ailing and waiting for their death. They're put into an ''home'' (what an euphemistic expression for something like this !) because the relatives (etc) want to get rid of them and simply don't want to be concerned. In those homes they just get the most basic supply like very bad food (just little, too), sometimes a fresh diaper if the nurse has time to do so, or they are bathed and they get their pills or another bag for their urine, etc. I was working in such a home (voluntarily) and there where I was working they had two times the nurses of an average 'home' and I really have to say: THERE WEREN'T ENOUGH NURSES AT ALL!
Nobody had the time to talk with those people or just to sit next to them, holding their hand and reading them something from a book or a newspaper.
Sometimes those poor ones told me that they have to go to the toilet and that they need somebody to help them ... (they almost cried) The nurses didn't have the time to do so since they had to 'take care'of the whole station and so even those who physically could had to use the diaper.
Even such suffering humans have a pride and feelings but -who cares? Money has a higher priority in humans than other humans.
People who could still eat something when somebody else helped them are just put on feeding tube because of the lack of time. They're suffering, dying of loneliness, bored and feeling like already being dead since the others treat them like that. I was asked several times (they really begged me if I could end their life) this was one of the worst moments in my life. I felt like being a cold murderer because I let them suffer there. I felt tempted to help them but I knew that this was something I could never do.
and honestly...since this I understand nurses who help those poor ones with dying. They simply can't help those poor ones even if they would do everything for it.

It's all a question of money... where the calculation starts humanity dies

There isn't just murder like in the case of Mrs Schiavo and others with a fate like this... the murder starts in the general treatment of those feeble ones. This is the true disaster. I really wonder about the cruelty of humans and the power of mammon. It's not a question of something political or a religious background. It's something which concerns all of us. We're all humans and sooner or later we'll be asking ourselves if there's really something like humanity when this world is like this. It's all in us to change it... so why do so few finally do something?

It's a shame

(58)
Anonymous,
April 14, 2005 12:00 AM

I just read Dr. Eisenberg's commentary on the death of Terri Schiavo. I too am very disturbed by the effect this will have on our society. I am an american christian and I work as a paramedic. I have seen a lot of disturbing trends in the medical field recently. While I only know the facts of Mrs. Schiavo's case from watching the media, I cannot understand why her parents were not allowed to take her and take care of her, if that;s what they wanted to do. I think the actions of her husband speak much louder than words here. Sincerely, Connie Christian

(57)
David,
April 14, 2005 12:00 AM

How many cases?

I really don't feel that this case was so much about the death of Terri Schiavo, but her request to not be kept alive artificially as determined by the court. Comparisons to Nazi horrors are really not called for in this case. On the other side, is every person to be kept alive on machines and feeding tubes as long as the body continues with minimal function? Terri Sciavo might have stayed "alive" for another 30-40 years with proper care. Is this what we all have to look forward to?

(56)
Sylvia Kaye,
April 14, 2005 12:00 AM

food/water deprivation

Did our sages ever envision a time when life could be sustained artificially thru a feeding tube and water intravenously? I would have to believe that withholding food and water for them meant not offering this to a person.

(55)
Dov,
April 14, 2005 12:00 AM

I agree with Dr. Eisenberg

In the end, it really becomes a very simple question. As Dr. Eisenberg said, do we value life for its apparent utility, or because there is something so undescribably meaningful about the state of life. Its exactly the slippery slope of determining who should live and die that we should never cross as a society. Though Mr. Bush and I fall on different sides of the fence most of the time, even without concrete answers, ultimately, we must err on the side of life.

(54)
Anonymous,
April 14, 2005 12:00 AM

Terri... kal va jomer with cerebral palsy

bsd (please forgive my english mistakes)
Today I spoke with a severe cerebral palsy(chronic non progressive encephalopaty) mothert who told me, how she cried seeing Terrie`s news. His daughter was born (third pregnancy) on an ambulance on her way to the hospital , with severe hipoxic damage and probably broncoaspiration of "meconius". She is now 20 yeras old, and also has a gastrostomy for feeding, since 1999. Almost the same story, but...not in USA but in Costa Rica. Her mother was 19 years old at that time, not married but living with a man 10 ,years older, who left in search of the "american dream", leaving her with three children and sending no money since then. She received some help fron the state, worked cleaning houses y asking G-d for strenght.
And she says: "mi daughter Angie is all my life, I was so sad seeing people arrested for traying to help Terrie, because we give even an animal food and water if he needs so..." She is not jewish, but this follows the halaja requiremente to feed animals before we eat.
As neurologist I disagre with my coleague . In this third world country we DO NOT remove tubes in any case of PVS or Dementia. We see our mission to help people, to preserve LIFE ...
Angie`s mother is economically poor but she is proud of his daughter.
Hashem Ishmor Otanu
Tizke le mitzvot
Todà Rabà.

(53)
DavidJove,
April 13, 2005 12:00 AM

Death be Not Proud

What I Learned from Michael Schiavo
By: Mendel Cohen
-----------------------------------

Terri Schiavo has died. It was a sad story, one that possibly should have remained a private family ordeal but turned into a news headline for thirteen long days. Scores of articles and news pieces have been written, many in favor of Terri's parents and siblings, less in defense of her husband, Michael. I do not wish to take sides. I wish to dwell upon a different aspect of the story, one which, for me, highlighted a concern we all share.

Every Friday I spend a few hours in Manhattan meeting with Jews from all walks of life in their businesses and offices. This is part of my weekly routine as a Chabad rabbinical student. We offer teffilin for men and Shabbat candles for women. We talk a little Torah and discuss the news.

This week, Rachel, a middle-class working mother, married for ten years, said to me the following: "You know, marriage today is different. It's not the life-long commitment it used to be. There is so much divorce. Nobody really devotes themselves fully to their spouse; in most cases, it's not even expected that they should. In the final analysis, you can't rely on someone who you have brought into your life for total protection. A parent," she continued, "is a source of unconditional love, your real lover and protector... It is a shame that our system allows for a husband (especially one living with another woman), to be the sole kin and decision maker on the spouse's behalf.

"You can ask all my friends, they will tell you the same," she concluded. "That's the way things are today."

I found her observation saddening. If "that's the way things are today," then we, as a society, are to blame. "Just imagine," I said to Rachel, "that the story had been in the reverse--that the parents wanted to remove the feeding tube and the husband was the one who insisted that he would take care of her and keep her alive. You would have surely said: 'Wow, what a hero! What a true and loving husband!' You would have praised the judicial system that had the wisdom and the faith to believe in marriage and in the inviolate commitment it engenders..."

I've been thinking about my conversation with Rachel all week. I thought about the Torah's perception of marriage: "Therefore, a man shall leave his father and his mother, and cling to his wife, and they shall become one flesh" (Genesis 3:24). I once heard a beautiful explanation for the term "one flesh." One flesh and not one mind, or one heart. Because to have one mind, friends can achieve that without getting married. The same goes with one heart, etc. One flesh, however, means not just an intimate encounter that unites a couple physically, but a union in which their physical and mortal needs become one. I care for you as I care for myself, because your needs--all the way down to the most basic needs of the flesh-- are my needs.

No other relationship is so strong--not that with a best friend, sibling, or even parent. These are indeed unconditional and deeply rooted; they arise from an earlier stage of life. But marriage is (meant to be) much stronger. It is not just meeting someone and bringing them into your life, a newcomer, hence not as strong as parental love, as Rachel imagined. Marriage is two halves of a soul becoming one. Her worries become your worries; his needs become your needs. One flesh.

Michael Schiavo may have dealt wrongly. He defiantly did not stay loyal, and there are a lot of speculations as to his intentions in taking the feeding tube out of a defenseless patient. However, one positive thing emerges from the tragic story: it underscored the age-old perception of marriage. The perception the Torah expresses when it says, "...and they shall be one flesh."

This should be a wake up call for all of us. Ask yourself: what have I done today for my spouse in taking care of his or her needs, physical and spiritual? Build love and appreciation for each other, like you have with no one else. Then you can rest assured that in times of stress, or G-d forbid illness, you can rely fully and unconditionally on each other, with true love, care and protection.

I once read a beautiful story of a newly married Israeli soldier who lost a leg in combat. When his wife came to visit him in the hospital, he said: "Darling, go find yourself a healthy husband with two legs." "No," replied the wife, "I didn’t marry your leg. I married you, and thank G-d you are still here."

May we all be blessed with healthy and happy marriages, and homes full of love.

(52)
Caroline Oostrom,
April 13, 2005 12:00 AM

Thank you for your comments

Thank you for standing up and voicing your thoughts for the sanctity of life.... may the Lord bless you... Shalom

(51)
Jerri McGarrah,
April 13, 2005 12:00 AM

Thank you

I appreciate the response of Dr. Eisenberg so much! As a nurse who has worked in the field of neurology and critical care, I have seen so many traumas that did not have good outcomes, but I always have supported life. I believe that our response to the most needy of our society is a reflection of our character and heart. These are more than medical issues. The Dr. who responded in support of Terri's death clearly has not reconciled his heart and his chosen profession. We all answer to Someone greater than ourselves - everyone! Every god falls before G-d, even Dr.s. Thank you again. jerri mcgarrah

(50)
Alison Raborn,
April 13, 2005 12:00 AM

Life/death of Terri Schiavo

Terri was dead BEFORE they brought her back to life. Her brain went without oxygen way to long. Her heart stopped. Medical Technology brought her back from the dead. Doctors need to stop playing G-D so family members do not have too 15 years later!! A profound mentally retarded person, a physically disabled person has brain waves. They are alive. Thier brains do not shrink and the crainal cavity does not fill with spinal fluid over time as with Terri Schiavo. Is it merciful to allow a person to lie there for years and rot away? Terri got good medical care because of a lawsuit. Many PVS cases don't have that luxury and in up in subcare nusing homes. Do you believe this is humane? Doesn't Terri's husband have a "right to life." The question about Terri Schiavo was not about life or death, but about "when to let go." Our culture fears death. We think we can cheat it, but sadly we can't. However there is hope. There is an after life. There is a G-D. We will have better bodies, a better life. And there is a Day of Judgment for those who wronged us. Why would anyone want to hang around in a PVS body when there is something awhole lot better!

(49)
Pam Jewell,
April 13, 2005 12:00 AM

It's frightening to me that not all medical doctors believe as Dr. Eisenberg does. I am fearful of what (or who) is next.

(48)
Michael,
April 12, 2005 12:00 AM

your article.

I don't know enough about the case to really comment about it, however,with your comments I wholeheartedly concur. I think only G-d has a right to take a life in illness. It seems to me that hospitals and doctors are increasingly subjecting their patients to a cost benefit analysis. A cold unfeeling medical profession increasing is becoming a business and a unethical one at that. How is it justified that the quality of medical care is commensurate with your ability to pay for it?

(47)
Bonnie Rogers,
April 12, 2005 12:00 AM

excellent article

I am a nurse and I can understand tired nurses wanting less to do on their shifts. Collusion with MD's in the murder of patients is not the way to do it. You said it well. What a slippery slope we are already sliding down.
Thanks for not being afraid to hang your opinion out for all to see.
Bonnie

(46)
Mordecai Drucker,
April 12, 2005 12:00 AM

True intellectual, scientist and Halachist.

It is indeed rare to combine correct application of Halacha and bona fide scientific methodology. The one who maintains this balance, while not diluting the validity of either side, is a true Jewish intellectual. I feel that Dr. Daniel Eisenberg, as exemplified by his articles appearing at aish.com, fits this description to a tee. From the "Golden Age" of Spanish Jewry until the present, there have been only a smattering of Orthodox Jews who play strongly in both fields, and santify the name of G-d as a result. I would include Dr. Eisenberg in this exclusive club.

(45)
Anonymous,
April 12, 2005 12:00 AM

Too complex for me.

Thank you for your concise commentary. This subject is very complicated. As an attorney, (I graduated at the bottom of my class), I trained myself to try to see both sides of the issue in the hopes that it would give me insight into my opponents way of thinking. In this case, I am at a loss. I consider the judges who ruled on this case to have more knowledge than I could ever have or want to have. None the less, your atricle was excellent, so thanks.

(44)
Dr. leon Wallace,
April 12, 2005 12:00 AM

Bury the dead.

It is immoral to provide the hospital expenditures that are in limited supply for a person in a vegetatuve state when it is absolutely clear that there are no human quaities remaining other than the physical features. When functioning adults and children are deprived of adequate medical care, while a vegetable in the form of a human eats up valuabe hospital space and costs, where are our true moral values? Hospitals need to be subsidized because medical expenses are so high. How much subsitdy was spent on a vegetable that might have gone to sick adults and children?
Leon Wallace M.D., psychiatrist.

(43)
Rivka Marchand,
April 11, 2005 12:00 AM

Baruch haShem for people like you

I made aliyah last week, and I suffered the Schiavo episode all the way through. I'm also a judicial interpreter, so I know the American mindset of judges and Court personnel. It is really demoralizing. We need more people like you to stand for morals.

(42)
Rosally Saltsman,
April 11, 2005 12:00 AM

Very insightful analysis

When considering the "utility" of life for those who feel people need a justification to be allowed to continue living, we need also take into account the fact that our lives matter to others. Terry's Schiavo's parents loved her. Her life mattered to them. We can't dismiss people's existence as unworthy as long as there are people who care about them. Receiving love and providing joy to others does not seem an inconsequential existence to me.

(41)
Annie,
April 11, 2005 12:00 AM

What a dilemma

What a dilemma. I am convinced that Terri Schiavo's reactions were reflexes, having seen this in patients when I was a nurse. She sometimes looked as if she was responding, but from another angle it was obvious that her eyes were glazed and that the 'smile' was a grimace. I would NOT want to be kept like that, with no dignity, just a living corpse.

I don't think that greed was the motive, as I believe that almost all the money is gone, spent on medical and legal expenses, and it would hardly be worth it for the tiny amount left.

I am very thankful to live in a country where medical and hospital expenses are taxpayer funded.

I can't help wondering how many of the protestors offered to either pay for the hospital expenses once the remaining money ran out or to look after Terri for the rest of her life. I can't believe that the decision was taken lightly by her husband. I would hate to be in that position.

(40)
Fernando Ya'akov Lalana, MD,
April 11, 2005 12:00 AM

Medical science is sadly turning into an issue of numerics and technology

As a cardiologist for the last 25 years I have had to deal with cases such as this. My stand agrees with Dr. Eisenberg's, and has been so since I started practice. Sadly medical science is turning into a numerical and technical show, treating a person as a collection of cells, and forgetting that the human has a soul and has all the rights to a moral existence, even though the patient has a severly debilitating illness. All efforts must be made to preserve life. Society is rapidly being contaminated with a detached attitude towards what constitutes a meaningful life.

(39)
marjolein van loenen,
April 11, 2005 12:00 AM

i stand corrected

I was of the school of thought that believes some lives are not worth living, and that in some cases the plug should be pulled. Dr Eisenberg's argument is strong: as long as a spark of G-d is within us, and given that G-d created us all, we have no right to make such life and death decisions. The horrors of nazi Germany are an effective illustration of the validity of that statement. I wish to thank Dr Eisenberg for reminding me. I stand corrected.

(38)
Harvey Mamon,
April 11, 2005 12:00 AM

comparing US doctors to Nazis is inappropriate

Dear Dr. Eisenberg,
I have no problem with your pointing out that Jewish medical ethics may differ from normative Western medical practice in saying that all life must be preserved, even in the case of PVS. Where I have a problem is in your comparing this policy to Mengele, and claiming that withdrawing nutrition from someone in a PVS inevitably leads down the "slippery slope" toward euthanizing retarded children. The truth is that there is nothing new in the Schiavo case about the question of withdrawing nutrition, which is standard practice around the world. The only reason this case made headlines was because of the difference between her husband and her parents in suggesting what she would have wanted. If she had left a living will with instructions not to maintain nutrition in the case of massive irreversible neurologic damage, the case never would have made the headlines. Nutrition would have been withdrawn, as happens routinely in similar cases, without all of the court cases and fanfare. Despite years of withdrawing nutritional support from patients such as Schiavo, I have yet to hear of anyone suggesting withdrawing feeding of retarded children or any of the other scenarios you present as inevitable consequences of the Schiavo decision. "Slippery slopes" may make for good rhetoric, but in real life they are not so slippery.

(37)
Anonymous,
April 11, 2005 12:00 AM

Dr. Would you like to be kept alive on feeding tubes if - forbid this situation would happen to you?

How would you react to this if a personal similar situation would happen to you or someone in your family?There are many different levels of disability, and perhaps each case should be considered as such.

(36)
Robert O. Begtrup, MD,MMAS,
April 11, 2005 12:00 AM

Dr. Eisenberg has it backward.

Dr. Eisenberg has it backward. Our problem is that non-medical people presume to be experts in the ethics of medicine. They are not. I doubt they ever can be. Physicians need to be better trained in ethics and be sensitized early in their educations to the reality that ethics is everpresent in the practice of medicine, and the standard case-specific utilitarian position, the one that maintains that the ethical action is that which obtains the best outcome for this patient, is inadequate to the challenges of the practice of medicine.
That being said, I must hope that what ever our differences in applying halakha to Mrs. Shiavo's case, Dr. Eisenberg cannot disagree with me that the most important effect of this terrible affair was the damage done to our system of law by the outrageous behavior our Congress and our President. That the assault on our Constitution was led by a doctor cum politician, the Senate Majority leader, is testimony to the everpresent danger of the disorder causing the physician to believe himself above the law, the disease often referred to as "M-Deity".

(35)
Ari Haviv,
April 11, 2005 12:00 AM

Terri had high quality of life

Despite her almost total lack of cognition, Terri was able to have a greater impact on our society than most people will ever dream of, including many of the most talented and gifted. She has taught us about the intrinsic value of all human life, the true love of a parent and the betrayal of our justice system. Terri had a greater impact than the millions of people who you will never hear about, who will never be acknowledged by presidents or any newspaper. Clearly she had a high quality of life because her name and story will be remembered for years to come.

(34)
Larry Schoen,
April 11, 2005 12:00 AM

Straw men not required

Even though withdrawal of treatment is usually not permitted, it is not the same as active intervention that causes death, and I wish the response could have made the point without this blurring. Also, the neurologist equates lack of cognition with lack of personhood or lack of humanity - he/she didn't equate it with death. The neurologist didn't discuss the "utility" of the life, he/she tried to parse whether the life was "human" or not. We can point out the inconsistency with Halachah, disagree with him, as I do, while more accurately representing his/her statements and positions.

(33)
Tova Schwed,
April 11, 2005 12:00 AM

How the U.S. values life

The U.S. values the lives of those who can be wage earners, tax payers and contributors to society. The U.S. values those they can benefit and take from. Torah values all people, those one can take from, as well as those whom we can GIVE TO! Terri Schiavo as well as others who are physically or mentally disabled, may not be able to give to others the same way that typically functioning people can, but these people are giving thousands of others the opportunity to show kindness and caring toward them. Perhaps this is why G-d does not make all people typically developing and perfectly healthy?! A world with no disease would become a very selfish world, for who else must we care for?

(32)
avigayil pechter,
April 11, 2005 12:00 AM

Who is deciding?

The points raised in this follow up article are very important.
There is such a fine line now being drawn by the American public as to what lives are worth saving and which ones are 'better off dying'.

As Americans we need to hope and pray for a judicial system that will respect the right of all of its population to live.
In Tanach, there are references there too of when the judges became morally corrupt. It seems now we are seeing that too. Hopefully we will see public opion be able to sway judges to be more aware of the repercussions of their actions.

(31)
Jeffrey A. Pomykala,
April 11, 2005 12:00 AM

....Wrong will be called "Right"

There is a certain book that tells us that towards the end of society as we know it, what is truly right will be called wrong, and things that are wrong will be called right. I believe we are seeing the beginnings of the fulfillment of those prophecies. Most polls show that the majority of people (70%+) believe Terri "should be allowed to die". Of course, the fact that she isn't dying and has now been starved to death (murdered) seems to elude most of the people who were for her death. It's against the law to starve an animal to death - yet most see no problem in starving a human to death. The overwhelming majority opinion in favor of this seems to be based on "quality of life", with many comments stating "how would you like to live like that!", because they themselves can't imagine being that way for 15 years.
My grandmother was bed-ridden after a stroke and was in that state for 21 years - after my father, grand-father and great uncle all passed away within one month, I moved in to take care of her and my great-aunt, who had a feeding tube for a few months due to an intestinal illness. We kept it in though, so she went on to live another 7 years...ahem. They loved the life they had. It might not have been much in the eyes of this present society - but they loved and lived it and there were many moments of joy, though, yes, there were also moments of (gasp!) suffering.
There is also a certain man that has ALS – a neurological disorder. Basically he’s a brain stuck in a body that doesn’t work, yet, he sure finds some great “quality” in life, though so many of us “can’t comprehend” that a wonderful life could be possible without a fully functioning body. This man is Steven Hawkings….one of the greatest physicists of the modern age. Ask him about “quality of life”.
While many of us currently profess we would want to die in similar situations as these people, I’d bet that MOST would change there minds if (G-d forbid!) they found themselves in a similar situation. Life is precious, and we should always err on the side of life.
Terri Schiavo was not suffering – she just wasn’t fully functioning in the manner that most people believe to be of “quality”. I know it’s been said she was “brain dead” – she wasn’t, she was brain damaged…and there IS a difference.
Some have stated (including doctors) that all her responses were merely autonomous “reactions” to the external stimuli – well, isn’t A LOT of even our own lives just that? If you really think about it, you’ll see that’s true. How many of us actually DO “think” beyond external stimuli?? Someone slaps us – we slap back. We’re “angry” today – because someone “said” something to us or we’re happy because of some external “nice” thing that has happened to us. Truth is a lot of our own actions are merely responses to external stimuli, though there may be more complicated thought processes involved. When one is truly “thinking” one can get beyond the mere physical response. Eg: someone snapped at us at work – our physical response is to get mad back…OR we can think beyond the physical response, realizing that they are “troubled” due to something else, and we consciously respond back in a nice manner – calming them – helping them. Yet, how many of us actually DO think beyond the physical immediate response? From what I see in the world, not too many of us….
I’ve had debates with people and have mentioned how allowing Terri’s murder (all in the name of a new “enlightened” moral clarity) now opens the door for much worse…like murdering downs-syndrome children and paraplegics or alzheimer’s victims etc. – all for “their own good”….or is really for OUR own good? As the article stated, and I believe it to be true, most are merely projecting their own “horror” at the idea of having to live life in such a condition that brings about their own “autonomous response” of “Let her die!”, instead of truly thinking through the full implications of the doors that are now open.
--the response I receive in debates where I mention that now the door is open and we will see more and worse? “Oh, that would never happen! You’re so melodramatic!” –
Tell that to the people of pre-ww2 Nazi Germany – who really were no different then you or I, believe it or not. They were also convinced about killing due to “quality” and you can bet that we, too, are now on that downward slippery slope of ethics that will allow “doctors” and other “learned” people to decide the fate of our lives.
We are certainly living in a time where what once was called “right” is now called wrong, and what once was considered wrong is now called right. It all sounds so pretty, moral and reasonable….but it’s still wrong in the eyes of our creator, as this article points out.
May Hashem have mercy on us all.

I am not Jewish by birth, but my entire being has nothing but Jewish qualities – I FEEL Jewish, I think Jewish (You want to debate? – lol) – I could easily believe that I must have Jewish blood in my veins. I wish that I myself could make the journey to Israel to live and help build and protect the Jewish nation, as I believe only the Jewish nation holds the keys to a better future for this world, as given to them by our creator.
I cannot tell you how proud I am that my brother Isaac, as represented by AISH and the morals of Jewish rabbis here at AISH, have written these articles in defense of LIFE!

May G-d bless you all at AISH and may the Jewish people continue to be the guiding light for a lost and troubled world.
…and may there be True peace in Israel, soon.

(30)
Rose Roper,
April 11, 2005 12:00 AM

Individual choices reap generational results

April 11, 2005

Dear Dr. Eisenberg,

Having just discussed this subject with my daughter and son in law last night at dinner I was quite
interested in reading your article.

With a deep sigh of relief I discovered that you had articulated eloquently, and in truth my exact words.
It is absolutely imperative that we speak up for life.
Individual choices reap generational results.
A few years ago I made a pin for myself on Election Day that was quite provocative. It read,
"If a man does not have the discernment to know when life begins,(and in this case should end) with whose wisdom shall he lead the nation."

This whole discussion on Terri Schiavo is indeed one that has unveiled the conscience of America.

I can't help but think of the famous exhortation of Mordecai in the book of Esther,
"For if you remain completely silent at this time, relief and deliverance will arise for the Jews (and in this case, those who cannot speak up for themselves)from another place, but you and your father's house will perish. (We reap what we sew by not speaking up,ignoring evil,individually, and as a nation)Yet who knows whether you have come into the kingdom for such a time as this." Esther4:14

Dr.Eisenberg, may the LORD continue to anoint the work of your hands.

Thank you for speaking out in Spirit and in truth.
Joyfully,
Rose Roper

(29)
Catherine,
April 11, 2005 12:00 AM

Again mankind is trying to build another Tower of Babel

As a nurse that works with disabled children, my heart aches that our medical establishment and the judicial system has sunk so low. How much longer can we expect mercy from Heaven?

(28)
Pam Cypel,
April 11, 2005 12:00 AM

No right answer

This is certainly a very sticky topic and one that brings a lot of emotional energy and much disagreement. I followed this to the best of my ability, and in the end, was still not sure as to what the right thing was. I for one would not want to live like that. So it certainly forced many people to make their wishes clear to the important people in their life, and hopefully, in writing.

More than anything though is the true question of "what is right". I don't think it is fair to say that because I may have believed that Terri would be better off with the Lord, I devalue life. I am a very spiritual and religeous person. And since I believe in the after life, death its self is not such a horrible thing if one has lived a full life. I also believe in personal responsibility and the laws of nature. It is a very sad story in deed of how Terri's personal choices led her down the path of physical demise. In fact it is tragic because she was ill and needed help which did not arrive in time. But in the end, I feel like G-d created us to live in a certain way. There were no feeding tubes 100 years ago. So if one were in Terri's postition she would not have survived, but then again G-d gave us great intellect. Natural laws would have taken their course. We have become so sophistocated medically that we can do maybe too much sometimes. When is it time to just say goodbye and not hang on because we can't bring ourselves to let go. I still don't have the answers to all these questions, but I don't think it is right to say it was unethical to let Terri die. Maybe it is unethical to keep people here. What is life? Certainly Nazi Germany went beyond what is conscionable. But where is the line drawn and who draws it? Maybe I value life more in the spiritual sense. What I find tragic is how she had to go. Starvation is cruel. If we did that to a dog we would be arrested.
So it is a very complex matter. I don't think anyone has the "right" answer. For many it is a very personal decision. I hope we all learned our lesson.

Thanks for hearing my voice.
Peace
Pam Cypel

(27)
Anonymous,
April 10, 2005 12:00 AM

Spot on!

This article hits the nail on the head. It is truly unbelievable how so called "intellectuals" have the utter arrogance to assume they have the ability and the right to make judgements regarding human life. Life is divine - every life - and is utterly without compromise. To claim otherwise is evil in its most pernicious manifestation.

(26)
Anonymous,
April 10, 2005 12:00 AM

let's not appoint guilt, look at the true facts.

What if Terri desired to go, but the machines wouldn't permit it.
sorry

(25)
Esther Mott,
April 10, 2005 12:00 AM

Terri Schiavo

I agree with Dr. Eisenberg. In the end, this wasn't about the patient's welfare at all, but about anger and politics, and originally, possibly greed.

(24)
Taste of Liberty,
April 10, 2005 12:00 AM

What if.... ???

Oh my...anonymous is playing fast and loose with human life. How we have cheapened the human being!
Some facts on Terri Schiavo:
Hearsay evidence existed on both sides regarding Terri's "desires". The judge only chose to listen to the hearsay evidence from Michael's side. (Under oath, Michael admitted he never heard Terri's comments. It was his brother who supposedly heard the comments at the nursing home.)
Food and water are hardly considered "machines". Terri was aware and responsive. Depriving any human of food and water is tortuous. The idea that it is blissful is bogus.

(23)
galia berry,
April 10, 2005 12:00 AM

the bottom line

Today it's supposedly about "ethics" but make no mistake, in our dollar-driven society, ultimately it will be about money. IMO, this will be the (very scary) scenario of the future: when it isn't "cost effective" to keep someone alive, insurance companies will refuse to pay, and eventually, the government (Medicare) will also refuse. Even people who, for religious and/or ethical reasons, wish to keep someone alive, they will be helpless to do so if they don't have the financial means to pay privately for extensive medical care. The legal decision to end Schiavo's life is the beginning of the end of our society as we've known it. We've sunk to an unfathomable abyss, and it's a very frightening picture indeed.

(22)
Anonymous,
April 10, 2005 12:00 AM

Conclusions based on confusion are often erroneus!

I was comforted by reading Dr. Eisenberg's insightful comments. Two thoughts: 1. I think that conclusions by doctors about such issues, even if based on hubris, primarily arises from the insecurity which results from confusion and uncertainty--the more confused their position, the more certain and far-reaching their conclusion. 2. Regarding the neurologist's comments on Alzheimer's and PVS as terminal--even IF those statements are true, it is far from certain that the proper approach to such a situation is intentional food and water deprivation.

(21)
Anonymous,
April 10, 2005 12:00 AM

Legally Sanctioned Confusion

The US legal system sentenced Scott Peterson to death for murdering his wife. Michael Schiavo received legal assistance to kill his, and I shudder to think what he may have done to further speed up the process as he sat alone with her in her last moments. America is in a state of legally sanctioned confusion, a morass of moral bankruptcy.

(20)
Susan Zale,
April 10, 2005 12:00 AM

Thank you for your article "The Death of Terri Schiavo: An Epilogue

I just finished reading the article and I also read the other pieces about this subject. We should all weep for the loss of compassion in our United States for those whose lives are described as "lives not worth living." Who are we to decide this?

(19)
Alistair Montgomery,
April 10, 2005 12:00 AM

Dr Eisenberg is right to hold fast to the sacredness of life in itself verses its "usefulness".

I too am a physician. The neurologist's position is the start of a slippery slope which I do not want to get on.

(18)
Anonymous,
April 10, 2005 12:00 AM

Thank You

Thank you Dr. Eisenberg. It is reassuring to know that there are ethical, caring, HUMAN and HUMANE physicians out there. The neurologist who wrote you seems so cold and uncaring, definitely not a physician I would want to help me make an end of life decision for a loved one.

(17)
Anonymous,
April 10, 2005 12:00 AM

Correct

Many will obviously be up in arms about this article, claiming that the comparisons are at least unfair and possibly even horrific. However, an honest man (and the medical profession in general) is now forced to take a step back and re-evaluate his policies, ethical opinions, and conduct.
This article is a real eye opener for the ordinary member of the public who puts his life in the hands of the doctors.

(16)
Helen (Chaiah) Schwab,
April 10, 2005 12:00 AM

As an orthodox Jew, I was horrified and angered...

Thank you for your excellent article. As an orthodox Jew, mother of eight and grandma of a bunch (B"H), I was horrified and angered that any person, especially one who was not even comotose!, would be starved and dehydrated to death.

You helped clarify a question I had after seeing Terri follow her father with her eyes and smile. I wondered if those muscular actions meant consciousness. Do I understand correctly that it is possible for them to be refexes? That would make the courts' point of view more understandable, though they still have no right to decide to murder an innocent person.

I suspect there was greed involved in this murder, and I'm dismayed that the courts would permit a person who would benefit from her death to be her guardian. Am I correct in assuming the husband stood to gain the use of those funds that were supposed to be used for her rehab? Also, how can an adulterer be a legitimate guardian for his wronged wife? I realize that is a question better asked of a lawyer than a doctor, but, perhaps you have heard that discussed as well.
Again, thank you for clarifying this vitally (no pun intended) important subject.

(15)
Jeanette,
April 10, 2005 12:00 AM

True Judgement

Dr. Daniel Eisenberg,
I have followed her story, and of all the readings on the Theresa Schindler-Schiavo case, I find your judgement the most accurate and honest and the closest to the heart of God the father for his people.
Thank you very much. The Lord bless you and keep you as you persevere in his wisdom and love.
Shalom,
Jeanette Lipinski

(14)
mindy,
April 10, 2005 12:00 AM

just my 2 cents

hi, i have followed this case for a while and i have wanted to tell SOMEONE what i think. i think that that husband and all those people have no right to decide what is life and what is not. may be according to them we should unplug all the people in nursing homes who need to fed. maybe all retatred children. it would save a lot of money --is that what all these people think. who do they think thay are. only G-d decides whao is supposeed to die.

(13)
Hana-Bashe Himelstein,
April 10, 2005 12:00 AM

Bravo

Those outside of the learned Orthodox Jewish community possess a limited or impaired understanding of the value of life. There was nothing merciful in her demise, so referring to her untimely death as a mercy killing is tasteless and contemptible. What transpired was court-sanctioned murder. Terry Schiavo was murdered, just as sure as Laci Peterson was – but while Laci's husband sits on death row, awaiting society's ultimate punishment, Michael Schiavo is now free to marry his girlfriend, liberated from the burden of his brain-damaged wife. Shame on her doctors who betrayed her, her lawyer who didn’t make a strong enough argument for just letting her be, and the hospice workers for abusing their position. My deepest sympathies go out to her parents and siblings, but most of all to Terry. We as a society failed her.

(12)
Patricia Findlay,
April 10, 2005 12:00 AM

When is it time to die?

I was very interested in your article and I agree 100%. I found it difficult to understand why when Terri Schiavo's feeding tube was removed, why didn't they then bury her cremate her at that time. Why wait until ALL her organs stopped working.

(11)
Judson E. Threlkeld, MD,
April 10, 2005 12:00 AM

One more thing

There is something uniquely human about caring for the "least of us". This is not just about Teri Schiavo, it's also about what we get in return for giving care to the "unloved" and injured among us. I would not expect any less from a Neurologist....they tend to be a "unique" sort.

(10)
Anonymous,
April 10, 2005 12:00 AM

not treating is not "killing"

The placement of a feeding tube is artificial and is a medical treatment. Withdrawal of an unwanted medical treatment should not be referred to as killing.

(9)
Raisy,
April 10, 2005 12:00 AM

life

I totally agree with Dr. Eisenberg, and in essence with the Halacha. We do see examples in Tanach of those who chose to end their lives. Life has ceased to be meaningful due to significant circumstances. Saul falling on his sword, the Jews of Masada, the Kohanim who plunged into the fiery depths of the burning temple. These people chose to end their lives--and, to my knowledge, no negative judgment is passed on them. It is different for one to decide that another must die. There we must stop short in reverence for another's life.

But there is room to recognized that for some life has become intolerable, and forgive them for that.

My son was brain injured due to a stroke following invasive medical procedures at age 2 and a half. He has been in a quadriplegic state for the past 10 years. At some point I wished for his death. Now I realize it was because I could not bear the pain. My son wants to live.

(8)
Mathew Silverton,
April 10, 2005 12:00 AM

Our descent into savagery

Dr. Eisenberg's argument implies the question, "Who among us is qualified to decree death for innocent people?"

And this is the essential question at issue here.

I have spent most of my life as a secular Jew and would, a few years ago, have wholeheartedly agreed with the neurologist.

But the question remains: who among us is qualified to act as the "angel of death?"

And if only certain, unsentient people can be killed now, how long before we broaden that category for our own utilitarian purposes?

Strangely, the scientific, rationalist, "enlightened" answer falls on the side of death. And the irrational, "archaic" religious values "choose life".

Personally I cannot help but choose the wisdom of my forefathers, as against an "ethics" based upon what is at bottom, savagery.

Mathew

(7)
TJ JOHNS,
April 10, 2005 12:00 AM

Terri Shiavo's case, was only the first well known case of legally euthanizing the disabled.

My late wife for example, was dying of cancer back in 1998 was refused help, because she had no assets, (that they could forclose on to get their money), and she refused to undergo anymore painful tests. (She was in the last stage)

The home nursing service disconnected her morphine (for pain), and Hospice refused to help her in the home, so they simply let her suffer until her heart finally gave out.

I've also been informed by many many nurses and nurses aid's in nursing homes, that if a patient can't feed themselves nursing homes do not see to it that they eat what is given to them.

Legalized Euthanasia is here and has been here, in my opinion for years, but society in general has turned a blind eye, simply because it does not involve them.

When will society wake up??? Probably when they are the one being starved to death, or made to suffer a horrible death because they don't have enought pain medication.

Just a sad sad thought...

TJ

(6)
Anonymous,
April 10, 2005 12:00 AM

I agree with Dr. Eisenberg and more.

It is not an irony lost on me that the day before Terry Schiavo passed away, I was doing some therapy consulting on our of bed positioning on a "coma unit", with every bed filled with "Terry Schiavo"s . While I agree that their lives are just that, LIVES, the commitment of those who clamor to maintain their state of being alive need to be more pro-active in maintaining some quality to that life. Nurses on that unit argued with me that these young men and women, many with case histories not too deviant from Ms. Schaivo's, need not be gotten out of bed more than once a week, that specialized positioning wheelchairs, etc. which would permit greater out of bed time, stimualtion, and stimulation, were a waste of time -- and these were the caregivers! Families are often barely present, in some cases these young adults have been in this state for over 20 years. The then teenagers or young adults are now in their thritie or forties and parents can not be there to the same degree. The volunteers who showed up in force outside of the hospice now need to stream inside of these facilites and volunteer to be visitors, "adopted" sisters, brothers, parents, to these very much alive human beings. While I wholeheartedly agree with the non-acceptablity of killing, I would strongly endorse shining a bright light on the quality of lives we are maintaining. It is not solely the medical professions who should make decisions about death, but we give them the right when we do not offer them any support during life.

(5)
Slava,
April 10, 2005 12:00 AM

Was Terri's own wish worth ANYTHING?

G-d gives us life and freewill and we are responsible for all our choices. I don't think most would dispute this. Medical nowledge, ethics, politics e.t.c. are arguably relative. Was Terri's own wish worth anything?

(4)
Tanya,
April 10, 2005 12:00 AM

Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less in human beings of whom they know nothing.
Voltaire (1694 - 1778)

Without undermining the valuble work of the Medical fraternity, lets not give them power of demi-gods, they cannot decide what life is viable to eat and who is not and they should not decide who lives and who does not..... like all societal erosion, it occurs in slow ¨justifiable¨ steps and when you look next you have lost so much ground a fair fight at restoring morality is almost out of reach.

As for the Doctor, Daniel Eisenberg responded to, shameful you are to presume you know the intricacies of all life, how arrogant, how rich, how presumptious... i guess you have the cure for the common cold too.

I hope you never endure the pain and powerlessness of her family and I hope that every Doctor I will ever need in my life is one that respects human life in all the forms it comes, I hope a Dr will never determine my life should be lifeless.

(3)
Anonymous,
April 10, 2005 12:00 AM

when does life end?

While I agree completely with you on the Schiavo case, I am wondering how one should indeed determine when life ends. It sounds as if you would define it as brain-stem death, perhaps, yet how is that more arbitrary than cortical death? It is of some practical concern in terms of harvesting organs for transplantation, if for no other reason. Thanks for any clarification.

(2)
Thomas Law,
April 10, 2005 12:00 AM

The death of Terri Schiavo

Very well written article Dr. Eisenberg. Thank you.

(1)
Anonymous,
April 10, 2005 12:00 AM

Support of the article and an additional resource on medical ethics

Thank you for writing this article. I am disabled and I see a grave problem in others defining which lives are worth living. I have had an incredibly blessed life and as a rehabilitation counselor, I have helped many other individuals with severe disabilities gain work and enrich their lives. I have great joy. And yet when I was severely injured as a child and my disabilities became evident, I had a few adults tell me that they had prayed I would die rather than to have such a difficult life. Thank G-d those people were not my doctors. Like you said, doctors have a responsibility to preserve life regardless of how they feel about the person or how they estimate the likelihood of the person having a good life. Only G-d can judge the true quality of anyone’s life.

I watched two videos by Berel Bell recently that could be useful to those who want to explore these issues more deeply. Berel Bell is a Hassidic Jew who extensive knowledge about the trends in medical ethics in the United States and beyond. He gave two informative lectures on medical ethics and the definition of life. I have included the website below where one can see those videos for free on the web. He brings up the fact that one can quickly move from medical considerations into something dealing with spirituality. He explains how we have defined death traditionally as occurring when the heart and the breath stop. He then goes on to say something I do not think most of us realize. An interdisciplinary team gathered at Harvard University to examine the possibility of redefining when death occurs. The motivation behind it was the desire to harvest organs from the dying to give to those who needed the organs. At the time this team gathered, doctors were afraid to do heart transplants because the heart needed to be beating at the time it was harvested from the donor, and the doctors were afraid they would be accused of murdering the donor patient. By the long standing definition of death, the doctor would be causing death to the donor when he took the patient’s heart. Now a stopped heart can be harvested; but the technology was not that advanced at the time of this interdisciplinary team gathering. This team of medical professionals, philosophers and theologians decided that death could be defined by the death of the brain. There were many aspects about the brain function that needed to be considered to make the determination of death. This new definition was quietly signed into law in many states without a public debate. It is defined at the state level. He points out the absurdity that if one is critically injured near a state line and the ambulance picks up the person, the person can become dead or stay alive simply depending upon which way the ambulance drives. Berel Bell is opposed to this new definition of death and gives multiple examples of how the new definition has already eroded medical practices in every country where it is practiced. The website for his lectures are at:

http://www.tiferes.org/archives4.htm

Notice on the left column where it says “intro to Medical Ethics”
Click on that for his first one hour lecture.
If you want to hear more on the issue, then click onto “Torah by the Sea spring session 6.3-13.04” toward the middle of the page and when it drops down, select “Berel Bell a closer look at Medical Ethics”. This second lecture follows the first and is a two hour lecture. These issues impact all of us and those we love.

I'm told that it's a mitzvah to become intoxicated on Purim. This puzzles me, because to my understanding, it is not considered a good thing to become intoxicated, period.

One of the characteristics of the at-risk youth is their use of drugs, including alcohol. In my experience, getting drunk doesn't reveal secrets. It makes people act stupid and irresponsible, doing things they would never do if they were sober. Also, I know a lot about the horrible health effects of abusing alcohol, because I work at a research center that focuses on addiction and substance abuse.

Also, I am an alcoholic, which means that if I drink, very bad things happen. I have not had a drink in 22 years, and I have no intention of starting now. Surely there must be instances where a person is excused from the obligation to drink. I don't see how Judaism could ever promote the idea of getting drunk. It just doesn't seem right.

The Aish Rabbi Replies:

Putting aside for a moment all the spiritual and philosophical reasons for getting drunk on Purim, this remains an issue of common sense. Of course, teenagers should be warned of the dangers of acute alcohol ingestion. Of course, nobody should drink and drive. Of course, nobody should become so drunk to the point of negligence in performing mitzvot. And of course, a recovering alcoholic should not partake of alcohol on Purim.

Indeed, the Code of Jewish Law explicitly says that if one suspects the drinking may affect him negatively, then he should NOT drink.

Getting drunk on Purim is actually one of the most difficult mitzvot to do correctly. A person should only drink if it will lead to positive spiritual results - e.g. under the loosening affect of the alcohol, greater awareness will surface of the love for God and Torah found deep in the heart. (Perhaps if we were on a higher spiritual level, we wouldn't need to get drunk!)

Yet the Talmud still speaks of an obligation on Purim of "not knowing the difference between Blessed is Mordechai and Cursed is Haman." How then should a person who doesn't drink get the point of “not knowing”? Simple - just go to sleep! (Rama - OC 695:2)

All this applies to individuals. But the question remains - does drinking on Purim adversely affect the collective social health of the Jewish community?

The aversion to alcoholism is engrained into Jewish consciousness from a number of Biblical and Talmudic sources. There are the rebuking words of prophets - Isaiah 28:1, Hosea 3:1 with Rashi, and Amos 6:6, and the Zohar says that "The wicked stray after wine" (Midrash Ne'alam Parshat Vayera).

It is well known that the rate of alcoholism among Jews has historically been very low. Numerous medical, psychological and sociological studies have confirmed this. The connection between Judaism and sobriety is so evident, that the following conversation is reported by Lawrence Kelemen in "Permission to Receive":

When Dr. Mark Keller, editor of the Quarterly Journal of Studies on Alcohol, commented that "practically all Jews do drink, and yet all the world knows that Jews hardly ever become alcoholics," his colleague, Dr. Howard Haggard, director of Yale's Laboratory of Applied Physiology, jokingly proposed converting alcoholics to the Jewish religion in order to immerse them in a culture with healthy attitudes toward drinking!

Perhaps we could suggest that it is precisely because of the use of alcohol in traditional ceremonies (Kiddush, Bris, Purim, etc.), that Jews experience such low rates of alcoholism. This ceremonial usage may actually act like an inoculation - i.e. injecting a safe amount that keeps the disease away.

Of course, as we said earlier, all this needs to be monitored with good common sense. Yet in my personal experience - having been in the company of Torah scholars who were totally drunk on Purim - they acted with extreme gentleness and joy. Amid the Jewish songs and beautiful words of Torah, every year the event is, for me, very special.

Adar 12 marks the dedication of Herod's renovations on the second Holy Temple in Jerusalem in 11 BCE. Herod was king of Judea in the first century BCE who constructed grand projects like the fortresses at Masada and Herodium, the city of Caesarea, and fortifications around the old city of Jerusalem. The most ambitious of Herod's projects was the re-building of the Temple, which was in disrepair after standing over 300 years. Herod's renovations included a huge man-made platform that remains today the largest man-made platform in the world. It took 10,000 men 10 years just to build the retaining walls around the Temple Mount; the Western Wall that we know today is part of that retaining wall. The Temple itself was a phenomenal site, covered in gold and marble. As the Talmud says, "He who has not seen Herod's building, has never in his life seen a truly grand building."

Some people gauge the value of themselves by what they own. But in reality, the entire concept of ownership of possessions is based on an illusion. When you obtain a material object, it does not become part of you. Ownership is merely your right to use specific objects whenever you wish.

How unfortunate is the person who has an ambition to cleave to something impossible to cleave to! Such a person will not obtain what he desires and will experience suffering.

Fortunate is the person whose ambition it is to acquire personal growth that is independent of external factors. Such a person will lead a happy and rewarding life.

With exercising patience you could have saved yourself 400 zuzim (Berachos 20a).

This Talmudic proverb arose from a case where someone was fined 400 zuzim because he acted in undue haste and insulted some one.

I was once pulling into a parking lot. Since I was a bit late for an important appointment, I was terribly annoyed that the lead car in the procession was creeping at a snail's pace. The driver immediately in front of me was showing his impatience by sounding his horn. In my aggravation, I wanted to join him, but I saw no real purpose in adding to the cacophony.

When the lead driver finally pulled into a parking space, I saw a wheelchair symbol on his rear license plate. He was handicapped and was obviously in need of the nearest parking space. I felt bad that I had harbored such hostile feelings about him, but was gratified that I had not sounded my horn, because then I would really have felt guilty for my lack of consideration.

This incident has helped me to delay my reactions to other frustrating situations until I have more time to evaluate all the circumstances. My motives do not stem from lofty principles, but from my desire to avoid having to feel guilt and remorse for having been foolish or inconsiderate.

Today I shall...

try to withhold impulsive reaction, bearing in mind that a hasty act performed without full knowledge of all the circumstances may cause me much distress.

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